Alendronic acid, Evacal D3 & teeth

[MaggieSylvie]

I got an appointment to see my dentist next month but have been reading that many dentists are not really aware of osteoporosis, so I'm wondering whether I should be thinking of coming off the drugs, as my teeth have recently become quite sensitive and seem to be getting more so. I haven't got osteoporosis but I am nearly 77. My compression fractures feel as if they are gradually healing, so I think I have had some benefit from the AA. However, I wouldn't have been prescribed them if I hadn't been in such pain, so I'm wondering why the five-year-rule exists. Is one year on AA detrimental? Does anyone know?

[Sunseaandsand]

Hi MaggieSylvie,

In the past I have seen a number of different dentists all of whom are well aware of the problems osteoporosis can cause regarding our dental care.

It is common practice that prior to seeing a dentist we are asked to list any medications and treatments we are taking or being given.

Every dentist I have seen will proceed with caution if you make them well aware that you are taking Bisphosponates.

If any invasive dental work needs doing at anytime in the future it will not be done by a dentist but by a specialist.

Our gums recede more as we age hence become more sensitive this can be helped by using a good toothpaste.

Sensodyne really does help if used regularly.

I can not understand your not having osteoporosis if you have had spinal fractures.

You woud not have been given AA for pain caused by fractures .

AA will not help with pain caused by fractures, it is given in the hope of strengthening the bones and as a result of this lessening our risk of further fractures.

As our fractures heal the acute pain lessens and often as a result of the changes in the shape of the spine we are left with chronic pain.

The five year rule was brought in as some people experienced atypical ( strange) fractures in the thigh bone after been on the medications for a long time. One year of treatment should be fine (although it is probably not long enough to build much bone).

Hope this is of a help to you.

Take care.

[MaggieSylvie in reply to Sunseaandsand]

Thanks for your reply, Sunseandsand. I had a DEXA scan in August 2019 that gave me a spinal T score of 0.2.

Then I got the fractures I was in dreadful pain and the GP I spoke to (in lieu of my own's absence) in February recommended AA; he said it would help prevent any future fractures and would address any possible osteoporosis. I also understood it would help to rebuild the bones but may have got that wrong. Eventually, in June this year, I got another DEXA which said - T score 1.0 (I was 76) and my risk for osteoporosis is 16%.

The pain is considerably less since starting AA, and I felt an improvement within a short space of time. Before that I was using a walking frame to reach the bathroom about three yards from the bedroom and screaming with the pain. At some point it was reported to me that my actual GP said she couldn't understand why I was in such pain from compression fractures (this is the same GP who has just diagnosed me with an underactive thyroid due to TSH that has dropped out of range).

I last saw my dentist about three years ago before being sent off to a specialist for extractions of wisdom teeth and at that time I had no medication to report. All my problems have happened since then. They are not doing any check-ups but have agreed to see me in a month because of sensitivity, which is new to me, and because of the medication. So I will see what they say. No point talking to my GP as she is, as others on this forum say, "clueless", and in due course I hope to change within the surgery. The doctor who prescribed AA along with EvalcalD3, has just retired, so he was unable to take me on.

I will seek more advice on how long to take AA for in my case. When it was prescribed I didn't have osteoporosis but it wasn't known. I think it was given as an alternative to strong pain killers and my GP removed all of them from my repeat prescription. I've just been taking paracetamol but have recently replaced that with Heal & Soothe. It is expensive but at least I'm not poisoning myself any more. I feel a bit better informed now with your help. Thanks.

[Sunseaandsand in reply to MaggieSylvie]

Hello again and thank you for your reply.

Your T scores are excellent especially for someone of your age!!

Could the scores you have been given be Z scores ?? ( Z scores are adjusted for age and so give a better result than a T score which needs to be below -2.5 to confirm osteoporosis.

If the scores are correct then perhaps it may be a good idea to question just what has been responsible for causing your fractures.

Regarding the age of your dentist, often the younger generation are more up to date with the newer treatments and what to look out for.

Please let us know how you get on.

[MaggieSylvie in reply to Sunseaandsand]

Thanks, Sunseandsand, I will not pre-judge the dentist.

I have only quoted spinal scores and my Z-score is 3.4. Femoral neck is 0.4 and Total hip 1.1, with a 3.5% risk of hip fracture.

The report also says"Reported Risk Factors: UK, Neck BMD = 0.658, BMI = 31.1, previous fracture, secondary osteoporosis. FRAX@Version 3.08. Fracture probably calculated for an untreated patient. Fracture probability may be lower if the patient has received treatment."

I didn't really pay much attention to this and am not aware of a fracture in my neck, only T4, which was the first compression fracture to give me trouble when I slipped and fell on my bottom, jarring my spine. I was sent to a physio class, pain clinic, etc. and used a TENS machine when I was doing activities that required several hours of stamina. Angulated T4 was discovered on an x-ray ordered by my haematologist some time later (they don't send you for x-rays - everyone gets sent to physiotherapy and there is never any diagnosis). So now it's too late to straighten that vertebra - I have scoliosis as well. I have been seeing a chiropractor and am considering going back to myofascial release that I had about 20 years ago.

What has been responsible for my fractures? First, the fall, as mentioned above, and then helping my partner lift paving stones. I was lifting the bottom of the trolley over all the thresholds to get them from the front to the back of the house (no side entrance). The fall was also caused by his failure to comply with my request to make the garden safe before he went away. After that, two more happened under far less strenuous circumstances, so I guess they were already primed to "go". The hospital report, following the lifting, said there was some deterioration in the spine and classified me as "frail" but sent me home with paracetamol! I've seen the x-ray recently and you can just see one compression fracture but it was not that badly compressed at the time, just excruciatingly painful. I had to fight a bit to get the x-ray. A later MRI scan (ordered by a physiotherapist) showed all four fractures quite clearly. It would be interesting to see the effects of the AA now that I have been taking it for eight months, but I can't see anyone doing any tests to satisfy my curiosity.

[Sunseaandsand in reply to MaggieSylvie]

Well looking at your scores it does appear your bone denisty is good and your risk of facture very low.

That for you is very good news!!

The femoral neck is the thin part of the hip joint, and it does say secondary osteoporosis which means in your case either by another medical condition or medications.

The effects of taking the AA is shown on follow up dexa scans, which are usually done every 2 years. I have a dexa yearly owing to the fact I am losing bone much more quickly than normal and they have never been able to say why this should be.

You may be asked for one also after a year, it may give a better indication what is happening.

I hope once your fractures have fully healed you will still be able to carry on without too many problems.

Good heavens!! lifting trolleys full of paving stones, top marks for your energy and strength but you really must be carefull.

I myself struggle to lift a mug of tea!!

It is good that your pain is easing now and you are mobile, but please take care as you know how excrutiating the pain of these fractures can be.

I really do wish you all the best with your health in the future.

You must have got something right with the scores like that.

[MaggieSylvie in reply to Sunseaandsand]

Thank you, Sunseaandsand for your uplifting response!

The only thing I can think of that might be causing the little problem with the hip joint is that on that side I have osteoarthritis of the knee but I was expecting OA to turn up in the other hip! A single paving stone is too much for either of us to lift, so it was a two-man job with him at the helm and me at the weight-bearing end. My GP obviously hasn't read beyond "compression fractures can occur without the patient being aware, and not be painful". Not only that but she hasn't followed up by sending me for any type of physio treatment. The only thing she's done is to take all painkillers except paracetamol off my repeat prescription without any discussion about it. I doubt she will order another DEXA scan as I had to fight for the latest one. She probably assumes I must have osteoporosis because I'm taking the AA. Hopeless.

I'm very sedentary, so that doesn't help much, but I am now able to stand long enough to prepare a meal; I'm not collapsing onto the perching stool so often, which is good because my partner keeps throwing it out of his way! Thanks for your good wishes - I was unaware of how good the scores are. I am a vegetarian, so "getting it right" gives me a certain amount of pride.

[Kaarina]

You mention somewhere else that you were refused a DEXA scan but prescribed AA is case you have osteoporosis, after a MRI showed up compression fractures. I am perturbed on reading this. Something has gone badly wrong somewhere along the line with your medical treatment and care. What was the reason given why you were not offered a DEXA scan?

My dentist is aware of osteoporosis and I believe most dentists are up to scratch with it and the drugs that are prescribed for it too.

You really do need a DEXA scan as a matter of urgency to find out what your T scores are.

[MaggieSylvie in reply to Kaarina]

Hi Kaarina, in reply to your question, I was refused a Dexa scan because it had not been two years since my last one. I was lucky to have phoned up the department and they were able to offer me a cancellation the next day, so I broke the two-year rule in the end. My T score in June for spine was 1.0 and that had risen from the previous score. Of course, most of my present health problems have started within the last 30 months, so yes - something has gone wrong with my care, and most would put it down to the pandemic, but add to that a clueless GP and a chaotic surgery and I feel that my previous good health is being taken for granted. Either that, or I'm approaching 77, so I don't matter. My haematologist is more proactive in getting all sorts of things done than is my GP.

I wrote in only because I had read posts from others saying that dentists are not aware of AA, and my dentists are all very young.

[Kaarina in reply to MaggieSylvie]

You could go private and pay for a DEXA but it would not be on the same machine so you could not compare the report with your previous DEXAs. One can only compare DEXA scans if they have been done on the same machine.Some of us have gone private and paid for a REMS scan (£150) which personally I find much more accurate than the ridiculous report I received from my last DEXA in August of this year. I had the REMS scan at the end of September this year. I shall definitely be paying for another one in two years time. healthunlocked.com/boneheal...

[Pinklady45]

Hi Maggie Sylvie,Be assured you are not the only 76 year old with a clueless GP and a chaotic surgery who feels because of her age and previous good health, not needing to see a Doctor very often( about once a year pre pandemic in my case) that she is being ignored and taken for granted!

See my previous posts!

After 2 years on AA I have come off of all Biphosphates and feel so much better in myself, also my teeth seem to have settled down and are not now so sensitive and somehow feel firmer in my jaw.

Good luck with your journey and stay safe. Pinklady45. 🌝

[MaggieSylvie in reply to Pinklady45]

Oh Pinklady45, you are the first person who has admitted the same problems as me! My jaw seems ok to me, except for a bit of bone that is floating along the side of my gum from back to front, but that has been there since the wisdom tooth extraction, and they say they don't know why it's there, but it doesn't bother me - that's pre Covid, pre everything! Can I ask why you stayed on AA for two years - not one and not five? Do you have osteoporosis? What did the medics say when you came off them?

[Pinklady45 in reply to MaggieSylvie]

Hi Maggie Sylvie

I stayed on first AA for 18months then switched to Risedronate because although the side effects were bad, fatigue, sore eyes, aching joints and more I knew no better and had yet to find this excellent website with its support and advice!

Being a good obedient type of Woman who always thought her Doctor knew best I just endured.

When the AA side effects got so bad I could no longer endure I waited 3 weeks for a most unsatisfactory telephone appointment with my very unsympathetic GP who just changed my prescription to Risendronate, though at first the side effects were not so bad then the pains in my legs/hips got so much worse very quickly as well as strange aches in my jaw and the feeling that all my teeth were loose and about to fall out!

I am fortunate in having a very good relationship with my excellent Dentist, so on my next check up visit, which was due

( she, unlike the Doctors has carried on throughout the Pandemic and all lockdowns) I explained all to her and as well as an extra deep inspection, including hitting all my teeth with her little hammer! we had a jolly good chat about Biphosphates and her and her colleagues thoughts on them.

It was an eyeopener I have to say and confirmed all I had felt within myself and learned from this chatroom, so I came out and said to my Husband, that's it my mind is made up I am not taking anymore of those pills. He, sweetie that he is said thank goodness and now says he has got his old Wife back as I feel better in myself than I have for years, in fact since starting out on the dreaded AA.

Over 2 years ago this same Doctor had told me I had Osteoporosis after stress fractures in my feet( which took her months to diagnose said my pain was Bursitis) and that my Dexa scan proved it.

It took me all of those 2 years to get the actual results out of her in fact had it not been for a very helpful receptionist who printed out the whole report for me I might never have found out the total truth, that I did not have Osteoporosis but Osteopenia which can be its precursor but not always.

I can not praise the Royal Osteoporosis Society highly enough for their advice and support, as I asked them to look at the full Dexa scan for me and tell me what it really meant.

I feel happy that I have made the right decision for me and am paying extra attention to my diet and exercises as recommended by the ROS. I am already feeling stronger in my legs and my balance has improved.

As to what my Doctor will say when I get around to letting her know, I really can not worry about that, I will advise her after another month when it will have been 3 months.

Hope this over long reply answers all your questions but let me know if you need more info. Stay safe and be happy.

Pinklady 45.💗

[MaggieSylvie in reply to Pinklady45]

Thanks, Pinklady45 for your lengthy reply. I haven't felt any ill effects of taking AA and Evacal. I do have symptoms but I had those before I started to take them. So I'm wondering, having only taken them since February, whether eighteen months would give me any benefits. It seems that bone strength rather than density is the thing. Tests have been done on parathyroids but they don't seem to be the culprits. AA is supposed to help with osteoporosis but does it do any good for bone strength? The only reason that I can see for suffering from this is my lack of exercise, which is, of course, even less these days. I'm glad you have benefitted from stopping taking them and I'm looking forward to doing so myself. Are there no specialists we can see?

[Pinklady45 in reply to MaggieSylvie]

The Royal Osteoporosis Society website and the excellent nurse led phone helpline/email line is always there for you to ask questions and give info. They are the only specialists we seem to have!! 💗

[MaggieSylvie in reply to Pinklady45]

Wow! Thank you for that! I've got encouragement from you and I can get information from the ROS! Many thanks.😘

[MaggieSylvie]

Well, I am paying for a chiropractor to help with the fractures, I am paying for natural painkillers, and I am just about to pay for thyroid testing due to my GP misdiagnosing an underactive thyroid. So perhaps later, a REMS scan would be in order but it won't help me and I won't have anything to compare the result with until I have another one. I'm cross enough that I'm having to do all this research into my conditions while my GP pretends to understand but actually knows nothing! I'm not kidding. Next week I hope to get some advice from a doctor friend and also have a chat with my haematologist; it could be that I don't need the tests, but I need to do things in a specific order, whether it includes getting tested or not. I do need a GP who abides by the motto "Do no harm" and who is still willing to learn.

[LynneH-19]

I cannot really add anything helpful to all your previous replies.

You don't appear to have OP which is good news. Lots of folk of various ages, still break bones, although they too don't have OP.

Fractures can be really painful, but the pain usually improves with time.

I was only on AA for 10 weeks, so I've no idea whether it helped the pain I had due to fractures.

Do you really need to stay on the AA, if you bone density is OK?

You need to discuss it further with your dentist and GP.

I always use toothpaste for sensitive teeth, as over the years I think the enamel on my teeth has gone thin, through over brushing them. I've tried various well known brands and cannot really tell much difference between them, except the cost. I'm presently using Sensodyne Pronamel because it was on offer at my local supermarket.

Best wishes

[MaggieSylvie in reply to LynneH-19]

I started to break bones in my early twenties - falling on my hands, then having road accidents in which the impact would have broken anybody's ribs/pelvis. I took care of myself after that. Apparently (I was reading last night) compression fractures never return to their original shape, so I'm going to be hard-pressed to keep an upright posture. They did say one of my wrist fractures was "an old lady's break" but when I mention Collis fractures now no-one raises an eyebrow and I don't have osteoporosis. My bones just aren't that strong, I suppose.

I will discuss AA first with my dentist, then change my GP and discuss it with the new one. I'm guilty of overbrushing, too, and have just bought some Sensodyne. I normally use different toothpastes all the time (going with the offers) but this is the first time I have had sensitivity to this degree.

Best wishes to you too.

[LynneH-19 in reply to MaggieSylvie]

Hopefully your dentist, or a new GP will put you on the right path, so all this worry over your bones will improve.Take care